European Journal of Case Reports in Internal Medicine <p><strong>The&nbsp;<span class="HPblu">European Journal of Case Reports in Internal Medicine</span>&nbsp;</strong>is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from&nbsp;<a href="">33 European countries</a>.&nbsp;<br><br>The journal’s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field.&nbsp;<strong><br><span class="HPblu">EJCRIM&nbsp;</span></strong>welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight, contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors).&nbsp;<strong><br></strong>The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.<br><br> <strong>EJCRIM</strong> is peer-reviewed with single-blind review and freely accessible to all.</p> SMC media s.r.l. - Via Giovenale 7, Milan - Italy en-US European Journal of Case Reports in Internal Medicine 2284-2594 <h3>Copyright and Disclosures</h3> <p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br> If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary Permission to Reproduce Published Material" forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional "Authorization to Publish" form is required from each corresponding copyright owner.</p> <h3>Copyright Transfer Declaration</h3> <p>(this may be included as a word document with your manuscript submission)<br> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br> I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br>The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/documents/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href=""></a></p> An effective treatment for multiple sclerosis urinary disorders through a formulation of Delta-9-tetrahydrocannabinol and cannabidiol: a case report <p>Spasticity represents an important cause of disability for patients with multiple sclerosis. Even more, dysfunction of the bladder greatly aggravates the patient’s burden and is responsible for their poor quality of life. Here, I report a case of a 35-year-old woman suffering from relapsing remitting multiple sclerosis, with a slight spastic para-paresis associated to an important urinary urge incontinence. The first-line antispastic treatments, physiotherapy and symptomatic drugs for urinary disorders did not bring any benefit. Instead, nabiximols relieved the woman's urinary symptoms, improving her sleep and quality of life without side effects.</p> LORENZO CAPONE Copyright (c) Strongyloides stercolaris infection in a male patient with unusual gastrointestinal tract manifestation and lower limb deep venous thrombosis: A case report <p><strong>ABSTRACT</strong></p> <p>We report a case of strongyloidiasis in a 48-year-old male who presented with gastrointestinal symptoms and developed acute cholecystitis and deep venous thrombosis. Strongyloidiasis is uncommon in Saudi Arabia but must&nbsp;be considered for patients with gastrointestinal symptoms who recently arrived from an endemic area or will begin immunosuppressive therapy.</p> Ibrahim Alnashri Copyright (c) Pyogenic ventriculitis associated with urosepsis – a rare case report <p>Pyogenic ventriculitis is an infection of the cerebral ventricles usually associated with neurosurgery or head trauma. There are less than ten reported cases of community-acquired pyogenic ventriculitis in adults. We present the case of a 71-year-old man with a medical history of type 2 diabetes mellitus, hospitalized due to urosepsis caused by E.coli. Because he had a fluctuant level of consciousness, he underwent magnetic resonance imaging that diagnosed pyogenic ventriculitis. He was treated with ceftriaxone 2g 12/12h for a total of 6 weeks and recovered without neurological deficits. Pyogenic ventriculitis is a clinical challenge for its rarity, atypical presentation and variety of etiological microorganisms.</p> Joana Correia Lopes Andreia Sofia Basílio Mário Amaro Copyright (c) CNS Demyelination under anti-TNF Medication; Coincidence or causal? <p>We describe the case of a 40-year-old patient with active Crohn’s disease (CD)-who developed neurological symptoms and was subsequently diagnosed with cerebral demyelination shortly after re-exposure to a therapy with Adalimumab. Based on the current state of scientific knowledge, we here discuss whether concurrent diagnosis of demyelinating disease and the anti-tumor-necrosis-factor (TNF)-alpha-therapy develop independently or whether&nbsp;direct causality&nbsp;is more likely. Basis for this purpose are the diseases´ incidence rates and the different pathophysiological hypotheses for demyelination under anti-TNF-alpha-therapy.&nbsp;Due to high incidence of cerebral demyelination and lack of laboratory or clinical markers to differentiate the underlying influences, a definite conclusion cannot be drawn. Based on the here presented findings and state of the literature, we finally deduce recommendations for clinical practice and research gaps.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> Hauke Christian Tews Annik Lundie Paul L. Tiemann Christian Sina Carlos Maaß Philipp C. Solbach Thomas F. Münte Jens Marquardt Copyright (c) An unusual infection: a case report of Staphylococcus capitis infective endocarditis complicated with spondylodiscitis. <p><em>&nbsp;&nbsp;&nbsp;&nbsp; Introduction: </em>Spondylodiscitis, consisting of the inflammation of vertebral bodies and/or intervertebral disk, is ?an infrequent, but potentially serious, infection. In relation to infective endocarditis, and while ?rheumatological complications are described, spondylodiscitis is rare, and seems to be associated with ?systemic embolization, mostly in patients with mitral valve involvement.<em> ?&nbsp;</em></p> <p><em>&nbsp;&nbsp;&nbsp;&nbsp; Case description: </em>A patient presented with history of general deterioration and unexplained, persistent fever, later complicated with severe lumbar pain. Upon admission, following the algorithm for fever with unknown origin, the diagnosis of <em>Staphilococcus capitis</em> infective endocarditis complicated with spondylodiscitis was reached.&nbsp;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp; <em>Discussion: </em>Spondylodiscitis is an infrequent complication of native-valve endocarditis, and <em>Staphilococcus capitis</em>, mainly a commensal, is a rare agent in both infections in the absence of surgery or prosthetic infection, highlighting the importance of also considering usual commensals in potentially serious infections.<em>&nbsp;</em></p> Luís Guilherme Santos Copyright (c) Granulomatosis with polyangiitis overlapping with IgG4-related disease? <p>IgG4-related disease (IgG4-RD) and granulomatosis with polyangiitis (GPA) share several clinical manifestations as well as the presence of ANCA antibodies and serum IgG4 immunoglobulins. Because of the imbricating clinical similarities, it is often difficult to distinguish the 2 entities delaying diagnosis and hence adequate treatment. There are very few compelling lines of evidence underlying the potential overlap between the two diseases. We hereby report the case of a 60-year-old patient portraying the clinical conundrum with clinical and biological features of GPA and IgG4-RD.</p> Aureliano Pistone Muhammad Soyfoo Copyright (c) Poland syndrome. A case that proves again to clinicians that every child must be completely undressed in physical examination <p>Poland Syndrome is an association of multiple congenital anomalies in a patient’s body. Most patients have absence or underdevelopment of pectoralis major muscle associated by possible athelia, hypoplasia of the breast, agenesis of cartilages and syndactyly. It is a rare syndrome, so to diagnose it every doctor can examine carefully and undress his/her patient. Herein, the presentation of a Poland Syndrome case proves the importance of undressing the patient to avoid misdiagnosis.</p> Katerina Kambouri Savas Deftereos Konstantina Bekiaridou Markos Markou George Voulgaris George Nistikoulis Nikolaos Papadopoulos Copyright (c) Miliary tuberculosis: remarkable cerebrospinal fluid <p>Tuberculosis remains one of the common infectious diseases. Miliary tuberculosis is a rare and possibly lethal form, due to lymphohematogenous dissemination of <em>Mycobacterium tuberculosis</em>. The authors describe the case of an 83 year-old previously healthy woman, diagnosed with miliary tuberculosis with both pulmonary tuberculosis and tuberculosis meningitis.&nbsp; Her remarkable yellow cerebrospinal fluid (CSF) and high CSF protein (&gt; 100 mg/dl) were different parameters between the tuberculous meningitis and control. Because prognosis largely depends on timely treatment, prompt diagnosis is important. Thus, treatment should be initiated as soon as the diagnosis is suspected.</p> Takanobu Hirosawa Shintaro Kakimoto Taro Shimizu Copyright (c) Immune thrombocytopenia in Helicobacter pylori infection and Sjögren’s syndrome with low complement component 4 <p>&nbsp;</p> <p style="margin: 0mm 0mm 0pt; line-height: 200%;"><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;">Immune thrombocytopenia is an acquired thrombocytopenia caused by antiplatelet autoantibodies. Immune thrombocytopenia</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: TimesLTStd-Roman; mso-font-kerning: 0pt;"> may occur in association with underlying diseases such as infection, malignancy, and autoimmune disease. However, most cases are classified as idiopathic immune thrombocytopenia and lack an identifiable cause.</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;"> W</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: '?? ?????'; mso-font-kerning: 0pt;">e herein described a case of </span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: TimesLTStd-Roman; mso-font-kerning: 0pt;">immune thrombocytopenia in a patient with <em>Helicobacter pylori </em>infection and Sj</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;">&ouml;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: TimesLTStd-Roman; mso-font-kerning: 0pt;">gren&rsquo;s syndrome with low complement component 4</span><span lang="EN-US"><span style="font-family: Century;">.</span></span> <span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;">Physicians should consider </span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: TimesLTStd-Roman; mso-font-kerning: 0pt;">Sj</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;">&ouml;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: TimesLTStd-Roman; mso-font-kerning: 0pt;">gren&rsquo;s syndrome</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;"> as an underlying disease of</span> <span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt;">Immune thrombocytopenia,</span><span lang="EN-US" style="line-height: 200%; font-family: 'Arial',sans-serif; font-size: 12pt; mso-fareast-font-family: TimesLTStd-Roman; mso-font-kerning: 0pt;"> particularly in patients with low complement levels and/or non-responders to <em>H. pylori</em> eradication therapy.</span></p> <p>&nbsp;</p> Jun Takeoka Tomomi Oka Kyoka Fujita Satoshi Kurahashi Naohiro Toda Toshiyuki Komiya Masaaki Fujita Copyright (c) Pulmonary Synovial Sarcoma - an unpleasant surprise <p>The authors describe a case of a patient with primary monophasic pulmonary synovial sarcoma presenting as a right pleural effusion and all the underlying diagnostic challenges.</p> Gabriela Pereira Ana Pires Sandra Barbosa Jorge Cotter Copyright (c)